P1544: IMPACT OF SARS-COV 2 INFECTION, IN TREATED NHL-B AND HD, AFTER VACCINATION AND PREVENTIVE THERAPY WITH ANTIBODIES: OUR EXPERIENCE
Authors: Luca Pezzullo, Valentina Giudice, Matteo D’addona, Danilo DE Novellis, Idalucia Ferrara, Raffaele Fontana, Roberto Guariglia, Serena Luponio, Maria Carmela Martorelli, Laura Mettivier, Bianca Serio, Carmine Selleri
Journal: HemaSphere (2023)

Topic: 30. Infections in hematology (incl. supportive care/therapy) Background: Coronavirus disease 2019 (COVID-19) is a life-threatening infection in patients with hematologic malignancies (HM), associated with severe clinical presentation and high risk of death. In December 2020, nearly 1 year after the first described COVID-19 case, vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were approved and became available first to patients at high risk,including patients with HM Aims: The purpose of the study is to evaluate whether the advent of vaccinations and preventive antibodies to contain the COVID infection could have improved the results on the severity of the infection in extremely immunosuppressed patients Methods: We evaluated in our Division, from January 2021 to January 2023, 250 patients (on treatment or who had finished treatment within 6 months) affected by non-Hodgkin B lymphoma (190 pts) or Hodgkin lymphoma (60 pts); 115 F and 135 M with a median age of 61 years (range 16-86 years). 95% of patients had received the recommended vaccination dose (median doses performed 2 with range between 1-4), while 40% of patients also received prophylactic therapy with tixagevimab-cilgavimab. Results: Of the 250 pts 116 (46%) had COVID infection (7 Delta variant and 109 Omicron); F 59 M 57 with median age of 59 years (range 16-81 years) 24 HD; 90 LNH-B and 2 HCL. Of the 116 pts, 26 (22%) had received prophylaxis with tixagevimab-cilgavimab. 31 pts (27%) had finished therapy within 6 months of infection, while 14 pts (12%) had finished treatment between 9 and 12 months before infection. 71 pts (61%) were in active treatment (39 pts in maintenance immunotherapy). Documented symptoms were mild in 74 pts (63%) median age 53 years; moderate in 22 pts (20%) and severe in 20 pts (17%) median age 65 years. Hospitalization was required in 32 pts (28%) and 23 pts (20%) died from COVID with a median age of 66 years. Of the 42 pts with moderate and severe symptoms (1 HD and 41 LNH-B) 16 had finished treatment within 6 months (1auto; 7 maintenance immunotherapy with anti-CD20 and 8 induction therapy of which 5 with combination therapy with anti-CD20 and bendamustine and 2 R-CHOP); 24 pts were in maintenance therapy (8 obinotuzumab; 12 rituximab; 2 ibrutinib and 1 lenalidomide) while 2 pts were in R-CVP induction treatment. In 20 patients, with mild symptoms and normal IgG and CD4+ values, we continued treatment despite COVID positivity: 10 HD (7 ABVD and 3 AdAVD) and 10 LNH-B (5 R-CHOP; 2 R-MACOP-B and 3 R -Bendamustine), 5/20 pts (25%) died, 4 due to disease progression and 1 patient due to myocardial infarction. No patients died from COVID complications. In 23 patients, in maintenance immunotherapy, the therapy was resumed (after COVID negativity) in 18/23 pts while in 5/23 pts (with IgG and CD4 values below normal values) it was definitively suspended. Summary/Conclusion: From our observation it seems that the COVID infection despite the advent of vaccinations and antibodies, has not muted the possibility of serious events in immune-suppressed patients, continuing to show a high mortality in this cohort of patients. Otherwise, it is probable that both vaccination and prophylaxis with tixagevimab-cilgavimab, can help in continuing treatment in these patients especially in induction therapy, where we have to evaluate the severity of the SARS COV-2 infection and we have to treat a haematological disease that would otherwise be undertreated. Keywords: COVID-19